Provider Demographics
NPI:1912971086
Name:THAKER, HARISH D (MD)
Entity Type:Individual
Prefix:
First Name:HARISH
Middle Name:D
Last Name:THAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 N RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1221
Mailing Address - Country:US
Mailing Address - Phone:954-854-2951
Mailing Address - Fax:
Practice Address - Street 1:1211 SE 2ND AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-1807
Practice Address - Country:US
Practice Address - Phone:954-524-6527
Practice Address - Fax:954-527-3732
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME232572084N0400X
FLME23527208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057676000Medicaid
FLD59955Medicare UPIN
FL057676000Medicaid